Pulse oximetry-guided rational use of oxygen in patients for ambulatory surgical procedures under spinal anesthesia

Background: In an effort to prevent and address perioperative hypoxemia, it has become customary to provide supplemental oxygen to all surgical patients. Recently, the value of such a practice has been questioned. This study was designed to determine the incidence as well as the potential risk factors associated with perioperative hypoxemia. Methods: During a 9 - week period, 84 ASA I-II patients who underwent ambulatory surgical procedures under spinal anesthesia were observed. Arterial oxygen saturation (SpO2) was monitored using a pulse oximeter prior to induction of anesthesia, during operation and until the patient was discharged from the recovery room. Patients breathed room air during the entire perioperative course unless dyspnea and/or desaturation occurred. Descriptive statistics was used to examine differences in oxygen saturations before, during, and after surgery. The association between each of the potential risk factors and the number of patients requiring supplemental oxygen was analyzed using Fisher's exact test (for attribute data e.g. level of sensory block) and the Wilcoxon's rank sum test for continuous data (e.g. age, smoking in pack years) to calculate the probability that the proportions did not differ. A/>< 0.05 was considered statistically significant. Results: The incidence of preoperative, intra-operative and postoperative hypoxemia was 0 percent, 0 percent and 1.14 percent respectively while the need for supplemental oxygen was 2.27 percent intra-operatively and 2.27 percent postoperatively. Statistical analysis revealed that the level of block and body mass index were significant factors (P < 0.05) influencing the need for oxygen support. The need for supplemental oxygen was not associated with age, smoking history, surgical position, sedation level and Visual Analog Scale score. Conclusion: Results suggest that seemingly healthy patients who undergo lower abdominal, urologic, gynecologic or lower extremity surgical procedures under spinal anesthesia are at a low risk for hypoxemia. Pulse oximetry as part of routine monitoring may obviate the need for supplemental oxygen in this patient population. (Author)

Validation and reliability testing of FLACC behavioral pain assessment scale in Filipino postoperative pediatric patients

Background:The FLACC (Facial expression, Leg movement, Activity, Cry, Consalability) behavioral pain assessment scale was developed and validated by Merkel and colleagues among American children last 1997 for autepain assessment of children 2 months to 7 years of age. Since then, it has been validated among other nationalities. It is now being used in Scotland, Australia, Canada and Thailland. This study aimed to determine the inter-reter reliability and construct validity of the FLACC on Filipino posoperative pediatric patients. Methods: A total of 106 children less than 5 years of age (1,68+1.46 years) who were admitted in the Philippine General Hospital Post Anesthesia Care Unit (PACU) were included. Those who are operated on an emergency basis, had neurologic impairment, had developmental delay and required menchanical ventilation postoperatively were excluded. Prior to the data collection phase, the PACU nurses were trained to use the FLACC scale using videotapes of postoperative children. Whenever possible, children were silmultaneuosly rated by two idependent ratersdurig their stay in the PACU. Those with FLACC scores>4 were given an intervention and the pain measurement was repeated and reported accordingly. Results: Inter-rater reliability was good to very good with kappa values for the pain behavior items ranging from 0.75 to 0.82. Construct validity ws established by showing a statistically significant reduction (p<0.001) beteen the pre-intervention score and post-intervention score using Wilcoxon signed rank test. Conclusion: The FLACC exhibited bith inter-rater reliability and contruct validity in the measurement of acute postoperative pain in Filipino children less than 5 years old.